Combined Motor and Cognitive Rehabilitation: The Impact on Motor Performance in Patients with Mild Cognitive Impairment. Systematic Review and Meta-Analysis.

Mild cognitive impairment (MCI), a neurodegenerative disease leading to Alzheimer's disease or dementia, is often associated with physical complaints. Combined physical and cognitive training (PCT) has been investigated to see the effects on cognitive function, but its impact on motor functions and activities of daily living has not been explored yet. The combination of physical and cognitive training may be a valuable non-pharmacological intervention that could preserve motor function and quality of life (QoL). We aimed, therefore, to analyze if combined PCT is effective at improving motor performance in patients with an MCI. A systematic electronic literature search and a meta-analysis were conducted. The following criteria were compulsory for inclusion in the study: (1) randomized controlled trial design; (2) combined PCT compared to motor training alone or no intervention; (3) motor outcomes as a study's end point. Nine articles met the inclusion criteria. Results showed that PCT significantly enhances balance compared to motor training alone (SMD 0.56; 95% CI 0.07 to 1.06; I2 = 59%; 160 participants), whereas a significant improvement was found for mobility in the PCT group when compared to no intervention (MD -1.80; 95% CI -2.70 to -0.90; I2 = 0%; 81 participants). However, there is no evidence that people with MCI experience an increase in gait speed and QoL at the end of their practice sessions. Further investigation with larger samples and a longer period of monitoring after intervention should be undertaken.

Non-invasive current stimulation in vision recovery: a review of the literature.

BACKGROUND: Around 253 million people worldwide suffer from irreversible visual damage. Numerous studies have been carried out in order to unveil the effects of electrical stimulation (ES) as a useful tool for rehabilitation for different visual conditions and pathologies. OBJECTIVE: This systematic review aimed to 1) examine the current evidence of ES efficacy for the treatment of visual pathologies and 2) define the corresponding degree of the recommendation of different ES techniques. METHODS: A systematic review was conducted in MEDLINE and Cochrane Library database to collect documents published between 2000 and 2018. For each study, Level of Evidence of Effectiveness of ES as well as the Class of Quality for the treatment of different visual pathologies were determined. RESULTS: Thirty-eight articles were included. Studies were grouped according to the pathology treated and the type of stimulation administered. The first group included studies treating pre-chiasmatic pathologies (age-related macular degeneration, macular dystrophy, retinal artery occlusion, retinitis pigmentosa, glaucoma, optic nerve damage, and optic neuropathy) using pre-chiasmatic stimulation; the second group included studies treating both pre-chiasmatic pathologies (amblyopia, myopia) and post-chiasmatic pathologies or brain conditions (hemianopsia, brain trauma) by means of post-chiasmatic stimulation. In the first group, repetitive transorbital alternating current stimulation (rtACS) reached level A recommendation, and transcorneal electrical stimulation (tcES) reached level B. In the second group, both high-frequency random noise stimulation (hf-RNS) and transcranial direct current stimulation (tDCS) reached level C recommendation. CONCLUSIONS: Study's findings suggest conclusive evidence for rtACS treatment. For other protocols results are promising but not conclusive since the examined studies assessed different stimulation parameters and endpoints. A comparison of the effects of different combinations of these variables still lacks in the literature. Further studies are needed to optimize existing protocols and determine if different protocols are needed for different diseases.

Linguistic analysis in the differential diagnosis between cognitive impairment and functional cognitive impairment (depression): a pilot study.

The differential diagnosis between cognitive impairment and functional cognitive impairment (depression) is complex and difficult, especially in the early stages of the disease. The aim of our study was to test linguistic analysis as a diagnostic tool to support clinical, and test-based diagnoses for this differential diagnosis. We enrolled 13 patients, requesting a diagnostic consultation in a Alzheimer Evaluation Unit. A provisional diagnosis through a neuropsychological evaluation (interview and neuropsychological tests) was made at baseline, while a definitive diagnosis was provided after six months, or, if not possible, after 12 months. The linguistic analysis was performed at T0 in blind by a linguist. Patients' language was studied at linguistic (morphological, syntactical, lexical literal and textual) and conversational (verbiage and humor) level. The correspondence rate between the linguistic analysis at T0 and the definitive diagnosis was 76.9%, compared to 58.4% between the neuropsychological équipe analyses at T0 and definitive diagnosis. There is no single patognomonic phenomenon for cognitive impairment or depression, but rather a linguistic cluster can lead to a diagnosis with a fairly good reliability.

Transcranial direct current stimulation (tDCS) combined with blindsight rehabilitation for the treatment of homonymous hemianopia: a report of two-cases.

[Purpose] Homonymous hemianopia is one of the most common symptoms following neurologic damage leading to impairments of functional abilities and activities of daily living. There are two main types of restorative rehabilitation in hemianopia: "border training" which involves exercising vision at the edge of the damaged visual field, and "blindsight training," which is based on exercising the unconscious perceptual functions deep inside the blind hemifield. Only border effects have been shown to be facilitated by transcranial direct current stimulation (tDCS). This pilot study represents the first attempt to associate the modulatory effects of tDCS over the parieto-occipital cortex to blindsight treatment in the rehabilitation of the homonymous hemianopia. [Subjects and Methods] Patients TA and MR both had chronic hemianopia. TA underwent blindsight treatment which was combined with tDCS followed by blindsight training alone. MR underwent the two training rounds in reverse order. [Results] The patients showed better scores in clinical-instrumental, functional, and ecological assessments after tDCS combined with blindsight rehabilitation rather than rehabilitation alone. [Conclusion] In this two-case report parietal-occipital tDCS modulate the effects induced by blindsight treatment on hemianopia.

Visual field restorative rehabilitation after brain injury.

About 20%-30% of patients undergoing neurological rehabilitation report visual field defects, one of the most frequent of which is homonymous hemianopsia (loss of the same half of the visual field in both eyes). There is still no consensus as to whether homonymous hemianopsia is best treated in a restorative or compensatory manner. The aim of this review is to describe the effects of restorative rehabilitation, whose long-term efficacy is still being debated. We analyzed 56 articles describing the use of various techniques used to promote visual field recovery but concentrating on two approaches: "border training," which involves exercising vision at the edge of the damaged visual field, and "blindsight training," which is based on exercising unconscious perceptual functions in the mild of the blind hemifield where the scotoma is deep. Both techniques have been supported by functional imaging studies showing evidence of cortical rearrangement (plasticity) after rehabilitation. Although no formal meta-analysis was possible, the results of a semiquantitative evaluation suggested that the improvement in visual skills obtained is related to the type of training used: Border rehabilitation seems to improve the detection of visual stimuli, whereas blindsight rehabilitation seems to improve their processing. Finally, the addition of transcranial direct current stimulation seems to enhance the effects of visual field rehabilitation.

Experience of group conversations in rehabilitation medicine: methodological approach and pilot study.

The restoring of equilibrium after a traumatic event makes it possible to give a new significance to patients' existence, and healthcare professionals simultaneously find themselves very close to questions of pain and disability. For these reasons, we introduced weekly group meetings of healthcare professionals and patients suffering from vascular, traumatic or neurological accidents, and meetings of professionals only at the Neurocognitive Rehabilitation Day Hospital of the University of Milan Bicocca. The aim of this paper is to identify possible indicators of changes in patients' existence through a conversational analysis, describing the experience at the light of methodological approach and reporting the results of a pilot observational study. The patient meetings began in October 2011 and led to a process of greater closeness and trust that was expressed by means of words, gestures, emotional participation, and non-verbal communication. The pilot considers the evolution of indicators in a sample of 14 patients for a period of 9 months and a timeframe of 3 months. Supportive interventions decreased while elements of sharing progressively increased, leading to progressive increased consciousness of both self and the disease. The group of professionals found that being together allowed them to distinguish performance as the use of their technical skills from understanding the other and his/her experience as part of their own, and not only linked to the disease. The professionals' reflections on their experiences led to the emergence of two possible ways of looking at a patient: as somebody other than me or somebody other like me.